Evaluation of A Polyherbal Formulation AV MBJ
Boswellia serrata tree is commonly found in India. The therapeutic value of its gum (sallaki) has been known. It posses good anti-inflammatory, anti-arthritic and analgesic activity. A randomized double blind placebo controlled crossover study was conducted to assess the efficacy, safety and tolerability of Boswellia serrata Extract (BSE) in 30 patients of osteoarthritis of knee, 15 each receiving active drug or placebo for eight weeks. After the first intervention, washout was given and then the groups were crossed over to receive the opposite intervention for eight weeks. All patients receiving drug treatment reported decrease in knee pain, increased knee flexion and increased walking distance. The frequency of swelling in the knee joint was decreased. Radiologically there was no change. The observed differences between drug treated and placebo being statistically significant, are clinically relevant. BSE was well tolerated by the subjects except for minor gastrointestinal ADRs. BSE is recommended in the patients of osteoarthritis of the knee with possible therapeutic use in other arthritis.
In a separate study the researchers showed that compounds from the gum with genuine antiinflammatory effects are pentacyclic triterpenes of the boswellic acid type. Boswellic acids inhibit the leukotriene biosynthesis in neutrophilic granulocytes by a non-redox, noncompetitive inhibition of 5-lipoxygenase. The effect is triggered by boswellic acids binding to the enzyme. Moreover certain boswellic acids have been described to inhibit elastase in leukocytes, to inhibit proliferation, induce apoptosis and to inhibit topoisomerases of leukoma- and glioma cell lines. A series of chronic inflammatory diseases are thought to be perpetuated by leukotrienes. In clinical trials promising results were observed in patients with rheumatoid arthritis, chronic colitis, ulcerative colitis, Crohn's disease, bronchial asthma und peritumoral brains edemas.
One of the ingredients most commonly found in Ayurvedic arthritis formulas is guggul, an oleoresin of the herb Commiphora mukul (CM). The authors have conducted both preclinical and clinical investigations of guggul for reduction of pain, stiffness, and improved function, and to determine tolerability in older patients with a diagnosis of OA of the knee. METHODS: The study was conducted using an outcome, quasi-experimental, model. Thirty male and female participants meeting the inclusion/exclusion criteria, with a score of 2 or more on the Kellegran-Lawrence scale for at least 1 knee, were admitted in the study. CM was administered in capsule form (500 mg concentrated exact delivered TID) along with food. The WOMAC Total Score was used as a primary outcome measure. VAS scales, 6-minute walk-test, and WOMAC subscales were used as outcome measures. RESULTS: At the end of treatment, there was a significant difference in the scores of the primary and secondary outcome measures. On the primary measure, WOMAC total score, participants were significantly improved (P < 0.0001) after taking the supplement for 1 month and continued to improve at the 2-month marker and follow-up. Secondary measures of pain in the VAS format demonstrated participant improvement; however, mood state, and current pain were not significantly different (P < 0.05) than baseline until the 2 month assessment (P < 0.001). CONCLUSIONS: Overall data indicate significant improvement for participants during the trial in both scales and objective measures used for assessment purposes. There were no side effects reported during the trial. CM appears to be a relatively safe and effective supplement to reduce symptoms of OA.
In a separate study, researchers at the Department of Physiology and Pharmacology, Royal College, University of Strathclyde, Glasgow, Scotland demonstrated the anti-inflammatory activities of extracts from the resins of four species of the plant family Burseraceae, Boswellia dalzielli, Boswellia carteri (gum olibanum), Commiphora mukul, and Commiphora incisa, were studied. The aqueous extracts of the resins of B. dalzielli, C. incisa, and C. mukul significantly inhibited both the maximal edema response and the total edema response during 6 h of carrageenan-induced rat paw edema. The octanordammarane triterpenes, mansumbinone and mansumbinoic acid, isolated from the resin of C. incisa, were separated and tested. Administered prophylactically, mansumbinone proved to be more than 20 times less potent than indomethacin and prednisolone in inhibiting carrageenan-induced rat paw edema. However, the molar potency of mansumbinoic acid was within one order of magnitude of those of indomethacin and prednisolone. The anti-inflammatory action of the acid on the carrageenan-induced edema was dose-related between 1.3 x 10(-5) and 2.5 x 10(-4) mol kg-1 when given before the inflammatory stimulus. The acid was able to reverse an established carrageenan-induced inflammatory response when administered 2 h after induction. Daily administration of mansumbinoic acid at a single dose level (1.5 x 10(-4) mol kg-1) significantly reduced joint swelling in adjuvant arthritis in rats. The results indicated that this compound is worthy of further investigation as an anti-inflammatory drug.
It is a pestiferous perennial weed with dark green glabrous culms, arising from a system of underground tubers. The plant has an elaborate underground system consisting of tubers, rhizomes and roots. The tubers are white and succulent when young, and hard and black when mature. Cyperine is the major constituent in the plant. The plant is a reputed hypotensive, anti-inflammatory & diuretic.
Ginger, the rhizome of Zingiber officinale Roscoe (Zingiberaceae), is a commom constituent of diet worldwide and it has been reported that its extracts present some pharmacological activities. Here the researchers investigated the effects of the crude hydro-proprietory extract of ginger rhizomes on the classical models of rat paw and skin edema. The carrageenan-, compound 48/80- or serotonin-induced rat paw edema were inhibited significantly by the intraperitoneal administration of proprietory ginger extract. Ginger extract was also effective in inhibiting 48/80-induced rat skin edema at doses of 0.6 and 1.8 mg/site. Rat skin edema induced by substance P or bradikinin was not affected by treatment with Z. officinalis extract. The intraperitoneal administration of ginger extract (186 mg/kg(-1) body wt.) 1 hr. prior to serotonin injections, reduced significantly the serotonin-induced rat skin edema. Our results demonstrated that crude extract of Zingiber officinale was able to reduce rat paw and skin edema induced by carrageenan, 48/80 compound and serotonin. The antiedematogenic activity seems to be related, at least partially, to an antagonism of the serotonin receptor.
In a separate study conducted at the Miami Veterans Affairs Medical Center and University of Miami, Florida, USA, 261 patients with OA of the knee and moderate-to-severe pain were enrolled in a randomized, double-blind, placebo-controlled, multicenter, parallel-group, 6-week study. After washout, patients received ginger extract or placebo twice daily, with acetaminophen allowed as rescue medication. The primary efficacy variable was the proportion of responders experiencing a reduction in "knee pain on standing," using an intent-to-treat analysis. A responder was defined by a reduction in pain of > or = 15 mm on a visual analog scale. RESULTS: In the 247 evaluable patients, the percentage of responders experiencing a reduction in knee pain on standing was superior in the ginger extract group compared with the control group (63% versus 50%; P = 0.048). Analysis of the secondary efficacy variables revealed a consistently greater response in the ginger extract group compared with the control group, when analyzing mean values: reduction in knee pain on standing (24.5 mm versus 16.4 mm; P = 0.005), reduction in knee pain after walking 50 feet (15.1 mm versus 8.7 mm; P = 0.016), and reduction in the Western Ontario and McMaster Universities osteoarthritis composite index (12.9 mm versus 9.0 mm; P = 0.087). Change in global status and reduction in intake of rescue medication were numerically greater in the ginger extract group. Change in quality of life was equal in the 2 groups. Patients receiving ginger extract experienced more gastrointestinal (GI) adverse events than did the placebo group (59 patients versus 21 patients). GI adverse events were mostly mild.
In a study by S. BANERJEE, S. K. BANDYOPADHYAY, P. K. MUKHERJEE, *ARATI MUKHERJEE AND *S. SIKDAR at the Department of Pharmacology, Calcutta National Medical College and University College of Medicine, Calcutta University & Department of Biochemistry, N.R.S. Medical College Calcutta , the authors demonstrated that the extract of the plant displays a significant anti-inflammatory activity against experimentally induced acute and subacute inflammation.